Exercise-Induced Syncope During Treadmill Testing in a Sedentary Woman: A Case Report

Vasovagal syncope (VVS), which is triggered by physical exertion, is typically observed in athletes or patients with structural heart disease. There have been few reported cases among sedentary individuals. This case report details the experience of a 42-year-old sedentary woman who fainted during a treadmill stress test. Despite the absence of abnormalities in baseline cardiac and neurological evaluations, the patient exhibited sinus arrest (lasting 5–12 seconds) with significant ST-segment depression during haemodynamic collapse. Comprehensive assessments, incorporating coronary angiography, echocardiography, cranial computed tomography (CT), and biochemical testing, excluded the presence of structural or ischemic heart disease, arrhythmogenic syndromes, and cerebrovascular disorders. A Calgary Syncope Symptom Score of 3 confirmed the diagnosis of VVS, a diagnosis that was further substantiated by the patient’s symptoms resolving spontaneously when she was positioned supine. This case demonstrates that exercise-induced syncope can occur in individuals who are physically unfit and have no cardiac abnormalities. Transient ST-segment changes in such cases reflect autonomic nervous system dysfunction rather than myocardial ischaemia. It is incumbent upon clinicians to consider a neurocardiogenic mechanism in sedentary patients presenting with exertional syncope despite a negative standard cardiac evaluation.